Related Experiment Video
Updated: Jun 20, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Consistent door-to-balloon times of less than 90 minutes for STEMI patients transferred for primary PCI
Bina Ahmed1, Stefan Lischke, Faye Straight
1Department of Cardiology, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA. bina.ahmed@vtmednet.org
Insights
A streamlined protocol improved door-to-balloon times for ST-elevation myocardial infarction (STEMI) patients in rural areas. Nearly 75% of transferred patients met the goal for primary percutaneous intervention (PCI).
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Less than 15% of ST-elevation myocardial infarction (STEMI) patients meet the door-to-balloon (D2B) goal of 90 minutes for primary percutaneous intervention (PCI).
- Achieving timely PCI is critical for STEMI patient outcomes.
- A streamlined protocol was developed to improve D2B times.
Purpose of the Study:
- To evaluate the effectiveness of a streamlined protocol for STEMI patient transfer and primary PCI.
- To assess the achievement of the ACC D2B goal (< or = 90 minutes) in a rural setting.
Main Methods:
- 37 STEMI patients were transferred 26 miles from a community hospital to a university center for primary PCI.
- Key time intervals measured: presentation to departure, transfer time, and PCI time.
- Total D2B time was defined as presentation to first balloon inflation.
Main Results:
- Median D2B time was 82 minutes.
- 73% of patients achieved the D2B goal of < or = 90 minutes.
- 94% achieved a D2B time of < or = 120 minutes, with most transfers occurring off-hours.
Conclusions:
- A simplified, streamlined protocol facilitates timely primary PCI for STEMI patients in rural settings.
- Transfer for PCI, even over ~30 miles, can achieve D2B goals in nearly 75% of patients.
- This protocol demonstrates the feasibility of rapid STEMI care coordination in remote areas.
Background:
Recent data from large national registries show that < 15% of patients with ST-elevation myocardial infarction (STEMI) transferred for primary percutaneous intervention (PCI) actually meet the door-to-balloon (D2B) goal of < or = 90 minutes, and only onethird achieve D2B times of < or = 120 minutes. We established a streamlined STEMI protocol to allow rapid transfer of STEMI patients for primary PCI to meet the ACC D2B goal of < or = 90 minutes in at least 75% of the patients.
Methods:
From February 2007 to August 2008, 37 consecutive patients presenting with STEMI to a community hospital in Vermont were transferred 26 miles to the University of Vermont (UVM) for primary PCI. Three time intervals were evaluated: presentation to departure time at the referring hospital, transfer time and UVM PCI time (time from arrival to the cath lab to balloon time). Total D2B time was defined as presentation to the first hospital to first balloon inflation.
Results:
The majority of transfers (69%) occurred off-hours. All patients received aspirin and clopidogrel and heparin pre-PCI. Median presentation to departure time at the STEMI referral hospital, total transfer and UVM PCI times were 26 (20, 33), 36 (34, 40) and 20 (16, 22) minutes, respectively. The median D2B time was 82 (77, 91) minutes, with 73% of patients achieving the goal D2B of < or = 90 minutes, and 94% achieving a D2B time of < or = 120 minutes.
Conclusion:
For patients in a rural setting who present with STEMI, transfer of approximately 30 miles for timely primary PCI can be achieved in nearly 75% of patients using a simplified streamlined protocol.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction